Rituximab, Methotrexate, Vincristine Sulfate, Procarbazine Hydrochloride, and Cytarabine With or Without Radiation Therapy in Treating Patients With Primary Central Nervous System Lymphoma

This study is currently recruiting participants. (see Contacts and Locations)
Verified July 2014 by Radiation Therapy Oncology Group
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Radiation Therapy Oncology Group
ClinicalTrials.gov Identifier:
NCT01399372
First received: July 20, 2011
Last updated: July 28, 2014
Last verified: July 2014
  Purpose

RATIONALE: Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some find cancer cells and help kill them or carry cancer-killing substances to them. Others interfere with the ability of cancer cells to grow and spread. Drugs used in chemotherapy, such as methotrexate, vincristine sulfate, procarbazine hydrochloride, and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high energy x rays to kill cancer cells. It is not yet know whether rituximab and combination chemotherapy are more effective when given with or without radiation therapy in treating patients with primary central nervous system lymphoma.

PURPOSE: This randomized phase II trial studies how well giving rituximab and combination chemotherapy with or without radiation therapy works in treating patients with primary central nervous system lymphoma.


Condition Intervention Phase
Chemotherapeutic Agent Toxicity
Cognitive/Functional Effects
Lymphoma
Neurotoxicity
Radiation Toxicity
Biological: rituximab
Drug: cytarabine
Drug: methotrexate
Drug: procarbazine hydrochloride
Drug: vincristine sulfate
Radiation: whole-brain radiation therapy
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Randomized Study of Rituximab, Methotrexate, Procarbazine, Vincristine, and Cytarabine With and Without Low-Dose Whole-Brain Radiotherapy for Primary Central Nervous System Lymphoma

Resource links provided by NLM:


Further study details as provided by Radiation Therapy Oncology Group:

Primary Outcome Measures:
  • Progression free survival (PFS) defined as the interval from randomization to progression or death, whichever occurs first [ Time Frame: From randomization to date of progression, death or last follow-up. Analysis occurs after 67 events (deaths or progression) have been reported. ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall survival (OS) defined as the interval from randomization to death due to any cause [ Time Frame: From randomization to date of death or last follow-up. Analysis occurs at the same time as the primary outcome analysis. ] [ Designated as safety issue: No ]
  • Response rate (partial response or complete response) [ Time Frame: Analysis occurs at the same time as the primary outcome analysis. ] [ Designated as safety issue: No ]
  • Quality of life measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core/Brain Cancer Module (QLQ-C30/BCM20) [ Time Frame: From start of treatment to five years. ] [ Designated as safety issue: No ]
  • Neurocognitive function measured by the Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test Part A, Trail Making Test Part B, Controlled Oral Word Association Test (COWAT) [ Time Frame: From start of treatment to five years. ] [ Designated as safety issue: No ]

Estimated Enrollment: 89
Study Start Date: September 2011
Estimated Primary Completion Date: December 2022 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Arm I
Patients receive rituximab IV over 5 hours or per institutional guidelines on days 1 and 15, methotrexate IV over 2 hours on days 2 and 16, vincristine sulfate IV on days 2 and 16 (of courses 1 and 2 only), and procarbazine hydrochloride orally (PO) on days 2-8. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive consolidation therapy comprising cytarabine IV over 3 hours on days 1-2. Treatment repeats every 28 days for 2 courses in the absence of disease progression or unacceptable toxicity.
Biological: rituximab
Given IV
Drug: cytarabine
Given IV
Drug: methotrexate
Given IV
Drug: procarbazine hydrochloride
Given PO
Drug: vincristine sulfate
Given IV
Experimental: Arm II
Patients receive rituximab, methotrexate, vincristine sulfate, and procarbazine hydrochloride as in arm I. After completing chemotherapy, patients without progressive disease undergo low-dose whole brain radiotherapy once daily, 5 days a week, for approximately 2.5 weeks (13 fractions total). Patients then receive consolidation cytarabine as in arm I.
Biological: rituximab
Given IV
Drug: cytarabine
Given IV
Drug: methotrexate
Given IV
Drug: procarbazine hydrochloride
Given PO
Drug: vincristine sulfate
Given IV
Radiation: whole-brain radiation therapy
Undergo radiotherapy

Detailed Description:

OBJECTIVES:

Primary

  • To determine median progression-free survival (PFS) in both arms on an intent-to-treat basis.

Secondary

  • To determine overall survival (OS) defined as the interval from randomization to death due to any cause.
  • To determine treatment-related neurotoxicity rates and disease-related cognitive deterioration in each arm, through the following methods: prospective formal neuropsychological evaluation, utilizing competing-risk methodology to account for death as a competing risk to neurotoxicity or cognitive deterioration from relapsed tumor burden/salvage treatment and incidence of clinically defined neurotoxicity as per investigator's assessment.
  • To determine if there exists differences between the two treatment arms in terms of health-related quality-of-life and symptoms over time.
  • To determine response (partial response (PR) and complete response (CR)) rate after methotrexate-based chemotherapy and after consolidation whole-brain radiotherapy (WBRT).
  • To determine chemotherapy-related toxicity, measured by Common Toxicity Criteria for Adverse Effects (CTCAE), v.4.0.

OUTLINE: This is a multicenter study. Patients are stratified according to Memorial Sloan-Kettering Cancer Center recursive-partitioning analysis (RPA) classification for primary central nervous system lymphoma on age and Karnofsky performance status (KPS) (Class 1: age ≤ 50 years vs Class 2: age > 50 years and KPS ≥ 70% vs Class 3: age > 50 years and KPS < 70%). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive rituximab IV over 5 hours or per institutional guidelines on days 1 and 15, methotrexate IV over 2 hours on days 2 and 16, vincristine sulfate IV on days 2 and 16 (courses 1 and 2 only), and procarbazine hydrochloride orally (PO) on days 2-8. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive consolidation therapy comprising cytarabine IV over 3 hours on days 1-2. Treatment repeats every 28 days for 2 courses in the absence of disease progression or unacceptable toxicity.
  • Arm II: Patients receive rituximab, methotrexate, vincristine sulfate, and procarbazine hydrochloride as in arm I. After completing chemotherapy (2-5 weeks later), patients without progressive disease undergo low-dose whole-brain radiotherapy once daily, 5 days a week, for approximately 2.5 weeks (13 fractions total). Patients then receive consolidation cytarabine as in arm I.

Patients may undergo blood and buccal sample collection for future correlative studies. Paraffin-embedded tissue block of primary tumor or a core tumor tissue punched from the tissue block, and cerebrospinal fluid may also be collected.

Patients may also complete the Hopkins Verbal Learning Test-Revised (HVLT-R), the Trail Making Test Part A and Part B, the Controlled Oral Word Association Test (COWAT), and the Quality of Life (QOL) questionnaires at baseline and periodically during study.

After completion of study therapy, patients are followed up every 2 months for 2 years and then every 6 months for 3 years.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • B-cell non-Hodgkin lymphoma (NHL) involving the brain, as demonstrated by contrasted MRI and histologic confirmation by one of the following within 6 weeks prior to registration:

    • A positive cerebral spinal fluid (CSF) cytology for lymphoma or a monoclonal lymphocyte population as defined by cell surface markers
    • A biopsy of the vitreous or uvea demonstrating NHL
    • Brain biopsy
    • Patients in whom the type of lymphoma could not be determined or is unknown (e.g., not enough tissue for further analysis) are assumed to have a B-cell lymphoma and are eligible
  • Patient must agree to submit tissue (i.e., the original H/E-stained slides and immunohistochemistry studies) for central pathology review post-registration
  • No evidence of systemic NHL as demonstrated by a CT scan of the chest, abdomen, and pelvis within 6 weeks prior to registration

    • Bone marrow biopsy is not required for registration but must be obtained prior to start of treatment

PATIENT CHARACTERISTICS:

  • History and physical examination within 6 weeks of registration
  • Karnofsky performance status (KPS) equal to 50% or higher, with the following exception:

    • KPS 30% to 50% are eligible if the reason for the poor performance status is neurologic deficit from primary central nervous system (CNS) lymphoma

      • Patients with KPS 30% to 50% due to reasons other than primary CNS lymphoma are ineligible
      • Patients with KPS under 30% for any reason are ineligible
  • Absolute neutrophil count (ANC) ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • Hemoglobin (Hgb) ≥ 8.0 g/dL (transfusion or other intervention to achieve Hgb ≥ 8.0 g/dL is acceptable)
  • Bilirubin < 2.0 mg/dL
  • Aspartate aminotransferase (AST) < 2.5 times upper limit of normal
  • Serum creatinine < 1.5 mg/dL
  • Calculated creatinine clearance (CrCl) > 50 cc/min (CrCl from a 24-hour urine collection may also be used)
  • Women of childbearing potential and male participants must agree to practice adequate contraception during therapy
  • Patient must be able to swallow pills
  • Patient must have documentation of negative HIV-1 testing within 6 weeks prior to study registration
  • No prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years (for example, carcinoma in situ of the breast, oral cavity, or cervix are all permissible)
  • No severe, active co-morbidity, defined as follows:

    • Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
    • Transmural myocardial infarction within the last 6 months
    • Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
    • Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy within 30 days before registration
    • Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

      • Laboratory tests for liver function and coagulation parameters are not required for entry into this protocol
    • Known pre-existing immunodeficiency as seen in organ transplant recipient
  • No prior allergic reaction to any of the study drugs involved in this protocol

PRIOR CONCURRENT THERAPY:

  • No prior treatment with chemotherapy or radiotherapy for lymphoma or chronic lymphocytic leukemia

    • Prior chemotherapy for a different cancer is allowable
  • No prior cranial irradiation
  • No concurrent intensity-modulated radiotherapy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01399372

  Hide Study Locations
Locations
United States, Alabama
The Kirklin Clinic at Acton Road Active, not recruiting
Birmingham, Alabama, United States, 35243
University of Alabama at Birmingham Active, not recruiting
Birmingham, Alabama, United States, 35294
United States, Arizona
Arizona Oncology-Deer Valley Center Active, not recruiting
Phoenix, Arizona, United States, 85027
Arizona Oncology Services Foundation Recruiting
Scottsdale, Arizona, United States, 85260
Contact: David G. Brachman    800-360-6371      
Principal Investigator: David G. Brachman         
United States, California
Kaiser Permanente-Rancho Cordova Cancer Center Recruiting
Rancho Cardova, California, United States, 95670
Contact: Samantha A. Seaward    626-564-3455      
Principal Investigator: Samantha A. Seaward         
Rohnert Park Cancer Center Recruiting
Rohnert Park, California, United States, 94928
Contact: Samantha A. Seaward    626-564-3455      
Principal Investigator: Samantha A. Seaward         
The Permanente Medical Group-Roseville Radiation Oncology Recruiting
Roseville, California, United States, 95678
Contact: Samantha A. Seaward    626-564-3455      
Principal Investigator: Samantha A. Seaward         
South Sacramento Cancer Center Recruiting
Sacramento, California, United States, 95823
Contact: Samantha A. Seaward    626-564-3455      
Principal Investigator: Samantha A. Seaward         
Kaiser Permanente Medical Center - Santa Clara Recruiting
Santa Clara, California, United States, 95051
Contact: Samantha A. Seaward    626-564-3455      
Principal Investigator: Samantha A. Seaward         
Kaiser Permanente Cancer Treatment Center Recruiting
South San Francisco, California, United States, 94080
Contact: Samantha A. Seaward    626-564-3455      
Principal Investigator: Samantha A. Seaward         
United States, Colorado
Penrose-Saint Francis Healthcare Recruiting
Colorado Springs, Colorado, United States, 80907
Contact: Alan T. Monroe    888-785-6789      
Principal Investigator: Alan T. Monroe         
United States, Florida
Edna Williams Cancer Center at the Baptist Cancer Institute Withdrawn
Jacksonville, Florida, United States, 32207
Cancer Specialists of North Florida-Southside Withdrawn
Jacksonville, Florida, United States, 32207
Cancer Specialists of North Florida-Beaches Withdrawn
Jacksonville Beach, Florida, United States, 32250
Cancer Specialists of North Florida-Baptist South Withdrawn
Jascksonville, Florida, United States, 32258
Cancer Specialists of North Florida-Orange Park Withdrawn
Orange Park, Florida, United States, 32073
Cancer Specialists of North Florida-Putnam Withdrawn
Palatka, Florida, United States, 32177
Cancer Specialists of North Florida-Saint Augustine Withdrawn
Saint Augustine, Florida, United States, 32086
H. Lee Moffitt Cancer Center and Research Institute Recruiting
Tampa, Florida, United States, 33612
Contact: Peter A. Forsyth    800-456-7121    canceranswers@moffitt.org   
Principal Investigator: Peter A. Forsyth         
United States, Idaho
Saint Alphonsus Regional Medical Center Recruiting
Boise, Idaho, United States, 83706
Contact: Samir Narayan    734-712-4673      
Principal Investigator: Samir Narayan         
United States, Illinois
Northwestern University Recruiting
Chicago, Illinois, United States, 60611
Contact: Jeffrey J. Raizer    312-695-1301    cancer@northwestern.edu   
Principal Investigator: Jeffrey J. Raizer         
Rush University Medical Center Recruiting
Chicago, Illinois, United States, 60612
Contact: Reem Karmali    312-942-5498    clinical_trials@rush.edu   
Principal Investigator: Reem Karmali         
Loyola University Medical Center Terminated
Maywood, Illinois, United States, 60153
Cadence Cancer Center in Warrenville Recruiting
Warrenville, Illinois, United States, 60555
Contact: Vinai Gondi    630-352-5300      
Principal Investigator: Vinai Gondi         
United States, Maine
Maine Medical Center-Bramhall Campus Recruiting
Portland, Maine, United States, 04102
Contact: Ian J. Bristol    207-396-8090    wrighd@mmc.org   
Principal Investigator: Ian J. Bristol         
Maine Medical Center- Scarborough Campus Recruiting
Scarborough, Maine, United States, 04074
Contact: Ian J. Bristol    207-396-8090    wrighd@mmc.org   
Principal Investigator: Ian J. Bristol         
United States, Maryland
University of Maryland/Greenebaum Cancer Center Recruiting
Baltimore, Maryland, United States, 21201
Contact: Navesh K. Sharma    800-888-8823      
Principal Investigator: Navesh K. Sharma         
United States, Michigan
Saint Joseph Mercy Hospital Recruiting
Ann Arbor, Michigan, United States, 48106-0995
Contact: Samir Narayan    734-712-4673      
Principal Investigator: Samir Narayan         
West Michigan Cancer Center Recruiting
Kalamazoo, Michigan, United States, 49007
Contact: Raymond S. Lord    269-373-7458      
Principal Investigator: Raymond S. Lord         
United States, Nevada
Nevada Cancer Research Foundation CCOP Recruiting
Las Vegas, Nevada, United States, 89106
Contact: John A. Ellerton    702-384-0013      
Principal Investigator: John A. Ellerton         
United States, New Jersey
Memorial Sloan Kettering Cancer Center at Basking Ridge Active, not recruiting
Basking Ridge, New Jersey, United States, 07920
United States, New York
Memorial Sloan Kettering Cancer Center Commack Active, not recruiting
Commack, New York, United States, 11725
Columbia University Medical Center Active, not recruiting
New York, New York, United States, 10032
Memorial Sloan-Kettering Cancer Center Recruiting
New York, New York, United States, 10065
Contact: Antonio M. Omuro    212-639-7202      
Principal Investigator: Antonio M. Omuro         
University of Rochester Recruiting
Rochester, New York, United States, 14642
Contact: Yuhchyau Chen    585-275-5830      
Principal Investigator: Yuhchyau Chen         
United States, Ohio
University of Cincinnati Recruiting
Cincinnati, Ohio, United States, 45267
Contact: Kevin P. Redmond    513-558-4553    uchealthnews@uc.edu   
Principal Investigator: Kevin P. Redmond         
Cleveland Clinic Foundation Recruiting
Cleveland, Ohio, United States, 44195
Contact: Erin S. Murphy    866-223-8100      
Principal Investigator: Erin S. Murphy         
Case Western Reserve University Recruiting
Cleveland, Ohio, United States, 44106
Contact: Erin S. Murphy    866-223-8100      
Principal Investigator: Erin S. Murphy         
University Pointe Recruiting
West Chester, Ohio, United States, 45069
Contact: Kevin P. Redmond    513-558-4553    uchealthnews@uc.edu   
Principal Investigator: Kevin P. Redmond         
United States, Oklahoma
Natalie Warren Bryant Cancer Center at Saint Francis Withdrawn
Tulsa, Oklahoma, United States, 74136
United States, Pennsylvania
Geisinger Medical Center Recruiting
Danville, Pennsylvania, United States, 17822-2001
Contact: Thomas J. Gergel    570-271-5251      
Principal Investigator: Thomas J. Gergel         
American College of Radiology Imaging Network Recruiting
Philadelphia, Pennsylvania, United States, 19103
Contact: Antonio M. Omuro    212-639-7523    omuroa@mskcc.org   
Principal Investigator: Antonio M. Omuro         
Thomas Jefferson University Hospital Recruiting
Philadelphia, Pennsylvania, United States, 19107
Contact: Jon Glass    215-955-6084      
Principal Investigator: Jon Glass         
Geisinger Wyoming Valley Recruiting
Wilkes-Barre, Pennsylvania, United States, 18711
Contact: Thomas J. Gergel    570-271-5251      
Principal Investigator: Thomas J. Gergel         
United States, Texas
M D Anderson Cancer Center Active, not recruiting
Houston, Texas, United States, 77030
M D Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Contact: Ivo W. Tremont    504-340-6976      
Principal Investigator: Ivo W. Tremont         
University of Texas Health Science Center at San Antonio Recruiting
San Antonio, Texas, United States, 78229
Contact: Chul S. Ha    210-567-0653    che@uthscsa.edu   
Principal Investigator: Chul S. Ha         
United States, Wisconsin
Community Memorial Hospital Recruiting
Menomonee Falls, Wisconsin, United States, 53051
Contact: Joseph A. Bovi    414-805-4380      
Principal Investigator: Joseph A. Bovi         
Froedtert and the Medical College of Wisconsin Recruiting
Milwaukee, Wisconsin, United States, 53226
Contact: Joseph A. Bovi    414-805-4380      
Principal Investigator: Joseph A. Bovi         
Waukesha Memorial Hospital - ProHealth Care Recruiting
Waukesha, Wisconsin, United States, 53188
Contact: Wingate F. Clapper    262-928-7632      
Principal Investigator: Wingate F. Clapper         
Israel
Tel Aviv Sourasky Medical Center Active, not recruiting
Tel Aviv, Israel, 64239
Sponsors and Collaborators
Radiation Therapy Oncology Group
Investigators
Principal Investigator: Antonio Omuro, MD Memorial Sloan-Kettering Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Radiation Therapy Oncology Group
ClinicalTrials.gov Identifier: NCT01399372     History of Changes
Other Study ID Numbers: RTOG 1114, CDR0000703682, NCI-2011-02678
Study First Received: July 20, 2011
Last Updated: July 28, 2014
Health Authority: United States: Federal Government

Keywords provided by Radiation Therapy Oncology Group:
neurotoxicity
chemotherapeutic agent toxicity
radiation toxicity
cognitive/functional effects
primary central nervous system non-Hodgkin lymphoma

Additional relevant MeSH terms:
Lymphoma
Neurotoxicity Syndromes
Radiation Injuries
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Nervous System Diseases
Poisoning
Chemically-Induced Disorders
Wounds and Injuries
Cytarabine
Methotrexate
Rituximab
Procarbazine
Vincristine
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antiviral Agents
Anti-Infective Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Abortifacient Agents, Nonsteroidal

ClinicalTrials.gov processed this record on August 21, 2014